From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.).
Radiology. 2024 Feb;310(2):e232044. doi: 10.1148/radiol.232044.
Background CT-guided high-dose-rate (HDR) brachytherapy (hereafter, HDR brachytherapy) has been shown to be safe and effective for patients with unresectable hepatocellular carcinoma (HCC), but studies comparing this therapy with other local-regional therapies are scarce. Purpose To compare patient outcomes of HDR brachytherapy and transarterial chemoembolization (TACE) in patients with unresectable HCC. Materials and Methods This multi-institutional retrospective study included consecutive treatment-naive adult patients with unresectable HCC who underwent either HDR brachytherapy or TACE between January 2010 and December 2022. Overall survival (OS) and progression-free survival (PFS) were compared between patients matched for clinical and tumor characteristics by propensity score matching. Not all patients who underwent TACE had PFS available; thus, a different set of patients was used for PFS and OS analysis for this treatment. Hazard ratios (HRs) were calculated from Kaplan-Meier survival curves. Results After propensity matching, 150 patients who underwent HDR brachytherapy (median age, 71 years [IQR, 63-77 years]; 117 males) and 150 patients who underwent TACE (OS analysis median age, 70 years [IQR, 63-77 years]; 119 male; PFS analysis median age, 68 years [IQR: 63-76 years]; 119 male) were analyzed. Hazard of death was higher in the TACE versus HDR brachytherapy group (HR, 4.04; < .001). Median estimated PFS was 32.8 months (95% CI: 12.5, 58.7) in the HDR brachytherapy group and 11.6 months (95% CI: 4.9, 22.7) in the TACE group. Hazard of disease progression was higher in the TACE versus HDR brachytherapy group (HR, 2.23; < .001). Conclusion In selected treatment-naive patients with unresectable HCC, treatment with CT-guided HDR brachytherapy led to improved OS and PFS compared with TACE. © RSNA, 2024 See also the editorial by Chapiro in this issue.
背景 CT 引导下高剂量率（HDR）近距离放射治疗（以下简称 HDR 近距离放射治疗）已被证明可安全有效地治疗不可切除的肝细胞癌（HCC），但比较该疗法与其他局部区域治疗的研究很少。目的 比较 HDR 近距离放射治疗与经动脉化疗栓塞（TACE）治疗不可切除 HCC 患者的患者结局。材料与方法 本多机构回顾性研究纳入了 2010 年 1 月至 2022 年 12 月期间接受 HDR 近距离放射治疗或 TACE 的连续未经治疗的成年不可切除 HCC 患者。通过倾向评分匹配比较具有临床和肿瘤特征匹配的患者的总生存期（OS）和无进展生存期（PFS）。并非所有接受 TACE 的患者均有 PFS 数据；因此，对于该治疗方法，使用了不同的患者集进行 PFS 和 OS 分析。风险比（HR）由 Kaplan-Meier 生存曲线计算得出。结果 经倾向评分匹配后，对 150 例接受 HDR 近距离放射治疗（中位年龄，71 岁[IQR，63-77 岁]；117 例男性）和 150 例接受 TACE（OS 分析中位年龄，70 岁[IQR，63-77 岁]；119 例男性；PFS 分析中位年龄，68 岁[IQR：63-76 岁]；119 例男性）患者进行了分析。TACE 组的死亡风险高于 HDR 近距离放射治疗组（HR，4.04；<.001）。HDR 近距离放射治疗组的中位估计 PFS 为 32.8 个月（95%CI：12.5，58.7），TACE 组为 11.6 个月（95%CI：4.9，22.7）。TACE 组疾病进展的风险高于 HDR 近距离放射治疗组（HR，2.23；<.001）。结论 在选择的未经治疗的不可切除 HCC 患者中，与 TACE 相比，CT 引导下 HDR 近距离放射治疗可改善 OS 和 PFS。©RSNA，2024 参见本期 Chapiro 编辑的评论。
